Provider Demographics
NPI:1083884738
Name:JEAN SENECAL MD
Entity Type:Organization
Organization Name:JEAN SENECAL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SENECAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-688-7455
Mailing Address - Street 1:825 W WASHINGTON ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1847
Mailing Address - Country:US
Mailing Address - Phone:334-688-7455
Mailing Address - Fax:
Practice Address - Street 1:825 W WASHINGTON ST
Practice Address - Street 2:SUITE 12
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1847
Practice Address - Country:US
Practice Address - Phone:334-688-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1083884738Medicaid
AL510G700185Medicare PIN